Same-Day Discharge Ambulatory Surgery Centers: The Importance of Preoperative Workup for Aesthetic Surgery Patients
Bibliographic record
Abstract
BACKGROUND: Limited resources combined with an increasingly "cost-conscious" approach to healthcare has resulted in a reduction of those preoperative investigations deemed unnecessary. Although this approach may work in the hospital setting where ancillary services and emergency support are readily available, it may actually be impacting patient safety in the ambulatory surgery center (ASC) setting. OBJECTIVES: The purpose of this study was to determine the prevalence of abnormal results arising from routine preoperative workup amongst patients undergoing aesthetic surgery in the outpatient ASC setting. The goal was to examine whether abnormal results led to alterations in care that otherwise would not have been made had the workup not been performed, and to outline patient factors associated with alterations in care. METHODS: A retrospective chart review was performed of 2596 consecutive patients who underwent aesthetic surgery over a 40-month period at a single Canadian ASC. Data collected included patient demographics, procedural characteristics, and outcomes. Preoperative workups were categorized as either required (for patients with positive findings on medical history and/or physical examination) or supplementary (for otherwise healthy patients). RESULTS: A total of 2581 patients met the inclusion criteria for the study. The majority of patients were female (91.2%) and had undergone breast surgery (60.3%). All patients underwent independent preoperative medical history and physical examination with bloodwork/screening. In total, 838 patients (32.5%) had abnormal bloodwork results, while 240 (9.3%) had abnormal electrocardiograms. These abnormal tests resulted in alterations in care for 242 patients (9.4% of total patients with 293 unique care alterations). Alterations in care included pharmacotherapy (n = 104, 35.5%), additional investigations (n = 78, 26.6%), specialist consultations (n = 67, 22.9%), and postponement of surgery (n = 44, 15.0%). Demographic variables associated with alterations in care included: age ≥50 years (P < .00001), female sex (P = .0235), higher ASA class (P < .00001), and pre-existing medical comorbidities (P < .00001). CONCLUSIONS: Preoperative workups are an important factor for improving patient safety in outpatient aesthetic surgery. These investigations can uncover occult issues that may increase the risk of complications in the ASC setting.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".